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Handouts for Workshop 21 on Thursday, December 10, 2009 8:30 11:30 AM

Advanced Empathy Training Helping the Angry, Mistrustful Client*

By David D. Burns, M.D. Adjunct Clinical Professor Emeritus, Department of Psychiatry, Stanford University School of Medicine
Dr. Burns' email: Website:

Copyright 2009 by David D. Burns, M.D. The materials in this handout are intended for your use during the workshop. Dr. Burns must grant written permission for all other uses or reproduction of any materials.

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Therapeutic Empathy / Burns

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Five Secrets of Effective Communication*

E = Empathy
1. The Disarming Technique (DT). Find some truth in what the other person is saying, even if it seems totally unreasonable or unfair. 2. Empathy. Put yourself in the other person's shoes and try to see the world through his or her eyes. Thought Empathy (TE). Paraphrase the other person's words. Feeling Empathy (FE). Acknowledge how the other person is probably feeling, based on what she or he said.

3. Inquiry (IN). Ask gentle, probing questions to learn more about how the other person is thinking and feeling.

A = Assertiveness
4. "I Feel" Statements (IF). Express your own ideas and feelings in a direct, tactful manner. Use "I feel" statements, such as "I feel upset," rather than "you" statements, such as "You're wrong!" or "You're making me furious!"

R = Respect
5. Stroking (ST). Convey an attitude of respect, even if you feel frustrated or angry with the other person. Find something genuinely positive to say to the other person, even in the heat of battle.

* Copyright 1991 by David D. Burns, MD. Revised 2004.

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Therapeutic Empathy / Burns

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Advanced Techniques* Changing the Focus

You focus on the process rather than the content of the argument. In other words, you might gently point out that the two of you are arguing and not working together as a team. You bring the conflict to conscious awareness in a kindly way, so you can both talk about your feelings, rather than trying to figure out who's right and who's wrong. In a sense, there's an elephant in the room, but everyone's ignoring the tension pretending it isn't there. When you change the focus, you point to the elephant and say, "Do you see what I see?"

Multiple-Choice Empathy
When you have no idea where someone is coming from, and they're reluctant to tell you, you can suggest several possibilities and ask if any of them ring a bell. It's like priming the pump. You might say, I can imagine you might be feeling X, Y, or Z. Do any of those words ring a bell? X, Y and Z could be words from the Feeling Words chart. Multiple-Choice Empathy can be especially helpful when the other person refuses to open up and tell you how they're feeling. You'll have to be disarming rather than blaming when you list the possible reasons why the other person doesnt want to talk to you. You'll also have to do this in a way that sounds caring, respectful, and concerned, and not demanding or condescending.

Positive Reframing
You put a positive spin on the situation. For example, you can reframe an angry conflict as a golden opportunity to develop a better relationship with the person youre at odds with, rather than viewing the problem as a prelude to Armageddon. You can also reframe the other person's motives or behavior in a positive way. For example, if someone seems stubborn, dogmatic, and argumentative, you could think of them as having intense conviction and desperately wanting you to understand them. You can also consider the almost possibility that you havent been disarming them in a genuine way, and thats the precise reason they keep arguing. Or, if a loved one is acting nasty, you could reframe their behavior as an expression of the hurt, loneliness, or frustration she or he is feeling.
* Copyright 2007 by David D. Burns, MD. Revised 2004.

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Therapeutic Empathy / Burns

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The Law of Opposites*

If you disagree with a criticism that is totally untrue and unfair, you will immediately prove that the criticism is entirely valid.

This is a paradox.

In contrast, if you genuinely agree with a criticism that is totally untrue and unfair, you will instantly put the lie to it.

This is also a paradox.

* Copyright 1991 by David D. Burns, MD. Revised, 2003.

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Therapeutic Empathy / Burns

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Feeling Words Chart*

Blue Down Disappointed Lost At fault Pessimistic Worthless Undesirable Weary Worn out Bored Alone Isolated Afraid Uptight Fearful Self-conscious Mortified Burned out Strained P. O.'d Irritated Furious Put down Intimidated Thwarted Mistrustful Unhappy Despairing Dejected Bad Desperate Flawed Incompetent Fatigued Lethargic Turned off Rejected Lonesome Scared Tense Frightened Flustered Embarrassed Tense Besieged Ticked off Incensed Enraged Insulted Defensive Stymied Suspicious Paranoid Disheartened Low Miserable Responsible Defeated Second-rate Defective Sleepy Wiped out Burdened Unloved Friendless Nervous Terrified Alarmed Awkward Timid Frazzled Overwhelmed Irate Annoyed Aggravated Judged Condemned


Sad Hurt


Ashamed Discouraged Inadequate Useless


Hopeless Inferior

Tired Unmotivated Lonely

Exhausted Drained Uninterested Abandoned Unwanted Worried


Apprehensive Panicky



Foolish Humiliated


Overworked Pressured Mad


Resentful Upset


Criticized Frustrated Jealous

Picked on Blamed Stuck Envious

* Copyright 1989 by David D. Burns, M.D. Revised 1992, 2000, 2003.

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Order Form: Therapists Toolkit (Includes the Massive 2009 Upgrade)*

The Initial Assessment Clinicians History Form Concept of Self-Help Memo How to Make Therapy Rewarding Memo Administrative Memo Session-by-Session Assessment Brief Mood Survey 1. Depression 2. Suicidal Urges 3. Anxiety 4. Anger 5. Relationship Satisfaction Scale Evaluation of Therapy Session 1. Therapeutic Empathy 2. Helpfulness of Therapy Session 3. Satisfaction with Therapy Session 4. Commitment to Doing Homework 5. Negative Feelings during session 6. Positive Feelings about session 7. What did you like, or dislike, the most? Powerful before-and-end of session scales Group Scales 1. Mood scales 2. Evaluation of Therapy Group Brief Mood Survey in 1. French 2. Spanish 3. Russian Chart Records New Children's Scales Sad Feelings (depression and suicidal urges) Anxious Feelings Angry Feelings Shy Feelings Hyperactive Feelings Therapist Niceness (Therapist Empathy) Therapist Helpfulness (Therapist Effectiveness) Relationship Assessment Brief & Full-Length Relationship Satisfaction Scale Anger 1. toward self 2. toward others Dangerousness Assessment Violent Fantasies Violent Plans and Urges Suicide Assessment 1. Self-report scales 2. Structured Suicidal Urges Interview Hopelessness Scale Motivational Assessment Willingness Scale Why Our Patients Resist Change Self-Help Report Scales for Use in Medical Settings Brief Mood Survey Satisfaction with Doctors Bedside Manner Satisfaction with Diagnosis and Treatment Brief Positive Feelings Survey Medication Record Side Effects Checklist Brief Pain Scale 1. Pain Right Now 2. Recent Pain Scales for Positive Emotions 1. Self-Esteem 2. Feeling Good About Others 3. Happiness 4. Productivity 5. Playfulness 6. Freedom from Fear 7. Hope 8. Spiritual Awareness Other Useful Tools

Self-Defeating Beliefs Therapists Report Card

Scales for Use in Supervision & Teaching Individual Therapy Tools Daily Mood Log Daily Mood Log Continuation Sheet Checklist of Cognitive Distortions 50 Ways to Untwist Your Thinking Cost-Benefit Analyses with instructions Pleasure Predicting Sheet with instructions The Anti-Procrastination Sheet Decision-Making Form with instructions The Anti-Hopelessness Memo 23 Common Self-Defeating Beliefs Interpersonal Therapy Tools Relationship Cost-Benefit Analysis Relationship Journal EAR Checklist The Bad Communication Checklist Five Secrets of Effective Communication Feeling Words Chart 12 GOOD Reasons 1. NOT To Listen 2. NOT To Express Your Feelings 3. NOT to Treat the Other Person with Respect Attitudes that Inhibit Intimacy Record-Keeping Progress Note (brief and detailed versions) Mood Records The Final Evaluation Termination Summary Patients Evaluation of Therapy And Much More License for Unlimited Photocopying No Royalty Fees

* Currently, the 2008 Upgrade is available via email attachment only

Fees and ordering information on reverse. A license cannot be sold or transferred. Electronic, internet or publication rights not included. US funds only. The EASY Diagnostic System is sold separately.

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Order Form
Yes! I want the Therapist's Toolkit!

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Item 1. Initial Toolkit. Comes with one license, includes 2008 Upgrade. Please add P&H below! 2. Postage and handling for each Toolkit mailed to US 3. Additional Toolkits at same agency. Each comes with one license. 4. Licenses for additional Therapist Toolkits. Additional individuals may be licensed for $100 per person, assuming you are all practicing at the same location. Multiply the number of therapists in your practice / facility / institution times $100. Does not include Toolkit. You must have at least one Toolkit to order additional licenses. 5. EASY Diagnostic System (Screening for 56 Axis I and 10 Axis II Disorders) 6. Additional Licenses for EASY Diagnostic System. Additional therapists must practice at same location as the therapist with the primary license.

Cost $229 $15 US $25 Can $165 $100 $149 $75

# Ordered



Subtotal Please add California sales tax if you are in California 8% of total Total Your name & degree: Street: City: Email address If you are ordering multiple licenses, include the name, address & phone # of every therapist who will be licensed to use the Toolkit. Send your order with a check to David Burns, M.D., 11987 Murietta Lane, Los Altos Hills, CA 94022. No purchase orders or credit cards. Please allow 3 - 4 weeks for TK delivery. Canadians send money order in US $. After you receive your Toolkit, send an email requesting the free 2007 Upgrade to The free upgrade comes as an email attachment. Use an email address that can receive attachments! The Therapists Toolkit is intended for use only by qualified mental health professionals. Phone: Suite: State: Zip:

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